Click here for full explanation of what should happen at your prenatal visits.

How your due date is calculated is often confusing and different from what you might expect. Pregnancy is 40 weeks, or 280 days, long when measuring from the first day of the last menstrual period. But conception occurs usually two weeks after the first day of the last menstrual period. This means that at the time of conception, a woman is already two weeks pregnant when measured this way. This assumes that her menstrual cycles are 28 days apart.

There are plenty of pregnancy due date apps and calculators that will tell you your estimated due date (EDD) based upon the first day of your last menstrual period (LMP). There’s even one on the front page of wonderfulpregnancy-com.preview-domain.com. Calculating your EDD from your LMP assumes a few things:

• That you remember the first day of your last menstrual period correctly;
• That you weren’t on birth control or something that would alter your cycles at the time of conception;
• That you have regular, 28-day cycles.

If your cycles are shorter or longer, your due date must be adjusted. If you don’t remember when your period was or you were on birth control at the time, you will probably have to be dated by an ultrasound. The earlier the ultrasound is performed, the more accurate it is for estimating your due date. Your doctor or midwife will help you figure out an exact due date at your first or second visit.

Many times, women don’t remember the exact day of their last menstrual period, or they may not have menstrual cycles that are exactly 28 days long, or they might have been on birth control at the time of conception. Sometimes women ovulate a little bit later than usual, or the bleeding they thought was their last menstrual period was actually related to the pregnancy (e.g., implantation bleeding). All of these factors mean that dating based on the last menstrual period is wrong about 40% of the time. Your doctor or midwife will determine your due date based on your last menstrual period and compare that to a due date determined by the earliest ultrasound, and in some cases, your due date will need to change based on the ultrasound.

As we said, the earliest ultrasound that you have is the best one to determine your due date. Sometimes, patients are confused because subsequent ultrasounds will show measurements that have a slightly different due date and they will wonder if their due date should be changed again based on these later ultrasounds. The answer is no. The later ultrasounds reflect a pregnancy that is just a little bigger or smaller than the average for that gestational age or vary just because of the margin of error of the scan.

Make sure you clarify at one of your first prenatal visits what your final estimated due date is; then, don’t get too fixed on that day. Only 2% of women deliver on their due date. Maybe we should’ve called it a due month!

Good question. The truth is, you can eat just about anything you want. Click here for a full explanation. The short answer is to not eat:

• Big fish with high levels of mercury (shark, swordfish, king mackerel, and tilefish)
• Unpasteurized milk and soft cheeses
• Raw or undercooked meats
• Cold cuts (lunch meat, salami, etc.)

Finally, make sure you wash your fruits and vegetables well before eating them. The absolute risk of the anything that happening from eating any of these foods is incredibly low. So you shouldn't worry too much; but pregnancy isn't the time to explore strange and new foods from uncertain sources.

Normal weight women (BMI of 18.5-24.9) should gain about 25-35 pounds during their pregnancies. Underweight women (BMI < 18.5) may need to gain more and overweight women less. For obese women (BMI > 30), dieting is safe and beneficial during pregnancy. Most weight gain comes in the second half of pregnancy and often women have gained no weight or even lost weight by their 20th week; this is healthy and okay.

We check your weight at every visit, but please don’t focus on how much you gain. We are usually not worried about you gaining too little weight but instead gaining too much weight. Excess weight gain increases the risks of several pregnancy complications, including the risks of preeclampsia, diabetes, fetal macrosomia (a big baby), and Cesarean delivery.

Many overweight women can gain no weight for the entire pregnancy or even lose some weight if they’re actively dieting. This is not a bad thing. Maternal weight gain, if it is excessive, is associated with a larger fetal size; but that doesn’t mean that gaining too little weight during pregnancy will not make your baby too small if you are overweight at the start of the pregnancy. The goal is to have a healthy baby and a healthy mom. Talk with your doctor or midwife about what your weight journey should look like throughout pregnancy based on your pre-pregnancy weight.

Yes, you can.

As with most things in life, moderation is the key. Scientific studies have not demonstrated any problems with caffeine consumption during pregnancy until a woman consumes over 700 mg per day. That’s a lot of caffeine! To be safe, and to make sure that a woman never approaches that amount of caffeine consumption, we recommend that women limit themselves to 350 mg of caffeine per day.

Click here to find out how much caffeine is in your favorite beverage.

Pregnant women are often excessively tired in the first and third trimesters, but probably for different reasons. In the first trimester, your body undergoes rapid physiological changes accompanied by high levels of hormones that conspire to exhaust you. Couple this with food aversion or nausea and vomiting, and the result for many women is complete exhaustion.

This tends to get better by the second trimester and then in the third trimester, particularly the last few weeks of pregnancy, exhaustion returns as you sleep less at night and carry around 30+ extra pounds during the day. If you have another small baby or two at home already, then the effect is even worse.

To help with symptoms in the first trimester, you can work on minimizing the effects of nausea and vomiting of pregnancy by eating several small meals or snacks throughout the day and adding vitamin B6 twice a day if you haven’t already. Naps sometimes feel like a good idea, but they often have the opposite effect than what you desire. Napping can interfere with your ability to get good rest at night and this can create a vicious cycle. Going for a walk or getting some exercise is probably a better idea and will improve your nighttime sleep.

Some women in the first trimester are excessively tired because they have cut caffeine completely out of their diets. Remember, you are still allowed to have up to 350 mg of caffeine per day; so don’t feel too bad about having that cup of coffee in the morning or maybe after lunch.

Many pregnant women need to work on maximizing their sleep hygiene. Make sure you have a dark room, maybe with a noisemaker, like a fan or something else that makes background noise, to minimize interruptions. Try to use your bedroom for sleep only; don’t make a habit of watching TV from your bed or staring at your phone. Women in the third trimester often find every little uncomfortable spring in their mattresses with their rounder bellies and hips. Try adding an extra layer of egg crate or a foam topper to your mattress and make sure you have a long pillow that you can hug with your legs. A hot shower about an hour before you go to sleep can also make a huge difference.

Also, be sure to empty your bladder right before you go to sleep and if you find that you are waking up to pee several times a night, you might need to restrict water intake for two to three hours before going to sleep.

In rare cases, excess fatigue might indicate another problem like a thyroid abnormality or anemia; if you feel like you are more tired than the average pregnant woman, be sure to talk to your doctor.

If you are occasionally tired or having a difficult time getting to sleep, tossing and turning, etc. an antihistamine like Unisom SleepTabs or Benadryl can be a safe option for moms to help with sleep. We recommend trying healthy sleeping habits before resorting to medications. Finally, if you are snoring a lot, you might have sleep apnea. A sleep study and treatment for this can be life-changing! Don’t hesitate to talk to your doctor about a sleep study while you’re pregnant.

Most women have traditionally learned the sex of their baby at the time of the anatomy ultrasound, at around 18 to 20 weeks. Today, most women find out earlier. If you happen to have an ultrasound any time after 14 weeks, usually the sex is visible. Ultrasounds at around 12 weeks can sometimes lead to a guess about the fetal sex (the angle of the dangle), but these guesses are only about 85% accurate.

If you choose to have NIPS performed, this includes the fetal sex so you may be able to find out as soon as 11 weeks’ gestation if you do the test at 10 weeks’ gestation.

Many women choose to not find out the sex of their baby until after it is born, but most women want to know. If you’re planning a gender reveal party, make sure you tell your doctor and your sonographer ahead of time so they don’t give away something accidentally. They can always put the answer in a sealed envelope. If you don’t want to find out until after the baby is born, make sure you tell whoever might do an ultrasound at any time that you don’t want to know; if it’s a later ultrasound, they will assume that you already know and they may say or show something that you don’t want to see.

The scientific ways of determining the fetal sex are:

• Ultrasound
• Noninvasive prenatal testing
• Amniocentesis
• Chorionic villus sampling

There are also some not so scientific ways that you’ll read about on the Internet. None of these work:

• Chinese gender charts
• Fetal heart rate (under 140=boy, over 140=girl)
• Wedding ring test (pendulum=boy, circle=girl)
• Peeing on Drano (brown=boy, no color change=girl)
• Carrying high vs low (low=boy, high=girl)
• Morning sickness (absent or mild=boy, present or severe=girl)
• Location of weight (belly=boy, hips and butt=girl)
• Placental location (right=boy, left=girl)

Most of these are harmless fun, but there are some products on the market that take advantage of these myths. Don’t waste your money.

Nausea and vomiting during pregnancy is no one’s idea of a good time. Unfortunately, it affects about two-thirds of pregnant women. The good news is, nausea and vomiting are not associated with risks to the pregnancy; the bad news is, you are nauseated and throwing up.

What can you do?

• Eat several small meals per day and avoid high-fat foods.
• Eat more bland foods and avoid smells that are noxious.
• Increase the protein and liquid content of your food.
• Ginger ale, ginger teas, or ginger capsules can help (three  250 mg capsules a day and one before bed).
• Taking a vitamin B6 supplement (25mg) 2-3 times per day alone or in combination with Unisom SleepTabs (doxylamine) at night may be beneficial.

Your doctor may need to prescribe an anti-nausea medicine for you if these remedies don’t resolve the issue. There are several drugs that are safe in pregnancy to choose from, including ondansetron (Zofran), metoclopramide (Reglan), promethazine, haloperidol, and a few others.

Make sure that your acid reflux and constipation are treated since both of those can contribute to nausea and vomiting as well.

In bad cases, you may need to be hospitalized for IV fluids and other treatments if you are unable to keep anything down and experiencing signs of severe dehydration/malnutrition.  Hopefully, you should feel better by the end of the first trimester. If you don’t, or if the above remedies are not working, your doctor may need to investigate other causes of your nausea and vomiting apart from pregnancy. Typically, you shouldn’t be concerned as long as you can maintain your body weight and stay hydrated during the first trimester. If you lose a few pounds from the nausea and vomiting, it isn’t too concerning; but, more significant losses should be investigated further.

Yes. The short answer is that exercise is a beneficial activity throughout pregnancy and virtually all pregnant women should exercise. Almost every limitation to exercise that you heard or read elsewhere on the Internet is not based in science. Women who exercise have better pregnancies in every aspect.

Read more about exercise during pregnancy here.

Almost all women have some cramping or other pains during pregnancy, particularly in the first trimester. This cramping is almost never anything to be worried about, particularly if you’re not bleeding. In the first trimester, the uterus grows rapidly and most of the cramping that a woman experiences is simply growing pains. As the uterus gets bigger, it becomes top-heavy and has a tendency to pull and tug from one side to the other. This will stretch ligaments, particularly the round ligaments of the uterus, and cause either cramping or sharp pains in the groin. None of these symptoms put the baby at risk.

Sometimes cramping is not related to your uterus at all. Many women become constipated during pregnancy and the cramping they experience is actually related to their bowels slowing down. Sometimes cramping is related to the bladder and might be a sign of bladder infection, but almost always there will be other symptoms like burning when you pee.

In the second and third trimesters, cramping is often what is called Braxton-Hicks contractions. We will talk about these contractions and compare them to real labor contractions later when we answer the question, “How can I tell if I’m in labor?”.

Every pregnant woman at some point in her pregnancy will begin to wonder if she is in labor. Most women have a few false starts. Braxton-Hicks contractions can be confusing and can become frequent and regular – at least for a short time – before going back to their irregular pattern. Women frequently have physiologic discharge or will urinate and wonder if their water is broken. So how can you tell real labor from false labor?

The answer is time. Real labor is progressive in every way, but you won’t be able to see this until some time has passed. If you’re having some regular contractions, the best thing to do is to see what happens over the next two to three hours. If you are really in labor, your contractions will become more frequent (maybe going from every six to seven minutes apart to every three to four minutes apart), last longer (going from, say, 30 seconds in length to 45 or 50 seconds in length), become more painful, regular, predictable, and persist. False labor, on the other hand, may start strong but will lose steam and wane over two to three hours.

If it’s your first baby, you have plenty of time. Labor will likely last many hours and you will have plenty of time to arrive at the hospital. If it’s your fourth baby, then you already know what to expect. If you are reading this anyway, your labor probably won’t last that long and you should head to the hospital a little sooner.

In some cases, your doctor may ask you to come to the hospital a bit earlier; for example, if you’re positive for group B Strepococcus, then you will need four hours of IV antibiotic therapy in addition to however long it takes to get to the hospital, get admitted, and get an IV started before the baby is born.

If your water breaks, you should probably head to the hospital. This may be a sign that your labor is already very advanced, since water tends to break on its own at an average of about 8 cm. If your water is broken and you’re not already in labor, then you should still go to the hospital because your labor likely needs to be augmented or induced. If you have had a previous Cesarean delivery, then you should come to the hospital much sooner because you do not want to risk laboring at home. A trial of labor after Cesarean is a good idea for most women, but because of the risk of uterine rupture, that trial of labor should happen at the hospital to maximize the safety for mom and baby.

In most cases, the answer is no.

There is a whole industry that markets supplements and other products to pregnant women. Even among prenatal vitamins, for most women the only ingredient that is actually required is folate, and folate is only necessary until the baby’s neural tube is closed, which happens early in the first trimester. The truth is, prenatal vitamins are best taken beginning at least two to three months before pregnancy and provide little to no benefit past the first half of the first trimester. In fact, if you are beyond six weeks and prenatal vitamins are making you nauseous or constipated, there’s no reason for you to keep taking them.

Aside from the folate in a prenatal vitamin, the other ingredients often found in these vitamins are not science-based. Don’t get caught up in buying the most expensive prenatal vitamin because the company says it will make your child smarter or reduce the risks of pregnancy; this simply is not true.

In some cases, due to restrictive diets or preexisting anemia or other risk factors, your doctor might ask you to take an additional supplement or medication, most commonly iron.

You can’t always tell; but, in general, once your water breaks, it keeps coming. Ruptured membranes are not just a small gush or a little bit of spotting; if you think your water has broken, clean up and see if the leakage persists. If it does or you are unsure, you probably need to be examined.

Discharge is common in pregnancy but usually never results in more leakage than would fill a small pad or panty liner. If you are getting cervical checks at your later appointments, the gel we use can sometimes appear later as a leakage of fluid but it is usually only a small amount and you would not see continued leakage.

Probably the most common reason why women believe that their water has broken is because they have peed on themselves. Most women cannot believe that they have peed on themselves, especially if they never felt the urge to pee, but in the third trimester with the baby’s head smashed right against your bladder, this is a common occurrence. If it happens on your bed sheets or in your underwear, you won’t always be able to tell that it is urine by smell or color alone. Amniotic fluid has a unique odor that is like a combination of ejaculate and bleach; that may not be helpful if you’ve never smelled amniotic fluid before, but when you do maybe you’ll recognize it.

All of this being said, large gushes with continual leakage after the fact should be assessed at the hospital or your doctor’s office. You may be ready to rock and roll!

Constipation is incredibly common during pregnancy; in the 19th century, some people called pregnancy the Disease of Constipation. The good news is that all the remedies and treatments you might normally use for constipation are still safe during pregnancy. You should start by increasing your water and fiber intake. Many women will add daily use of MiraLAX or a generic equivalent to their diet. This is a gentle agent that is non-stimulating and safe to use during pregnancy. If it has been a few days since your last bowel movement, you may need to stimulate a bowel movement from below. Try using a suppository (e.g., glycerin or Dulcolax), and if this doesn’t work you can repeat it in two hours.

If these over-the-counter remedies are not helpful, talk to your doctor.

You’ve probably heard the folktale that a lot of heartburn means that your baby will have a lot of hair; this probably isn’t true, but dreams of a well-coiffed baby undoubtedly won’t make your pain any better.

Heartburn aka acid reflux aka GERD is a common problem during pregnancy and gets worse throughout the third trimester for most women as the uterus grows and puts more pressure on the stomach. If you have occasional symptoms, avoiding trigger foods and using TUMS may be enough. For persistent symptoms, it is okay to use over-the-counter medications like TUMS, Gaviscon, Maalox, or Mylanta, as well as OTC or prescription antacid medications such as proton pump inhibitors (omeprazole, pantoprazole) and antihistamines (cimetidine).

Click here for a list of medicines that are safe to use during pregnancy.

In general, the answer is yes. Under normal circumstances, travel during pregnancy is safe until the last 5 weeks or so of pregnancy. This includes flying. Most cruise ships will not allow you onboard if you are pregnant past a certain gestational age. Be sure to drink plenty of fluids, walk, and stretch your legs on long trips.

You should take normal precautions while traveling, such as wearing seat belts. The lap belt should be below your belly so that it fits snugly across your hips and pelvic bone; the shoulder belt should be across your chest (between your breasts) and over the mid-portion of your collarbone (away from your neck). Never place the shoulder belt under your arm or behind your back; also, ensure there is no slack in the belt and that your airbags are turned to “on.” Keep 10 inches between the steering wheel and your breastbone. You may need to angle the steering wheel toward your breasts, not your belly or head.

There is nothing inherently dangerous about traveling by ground, sea, or plane during pregnancy. However, you do have to consider how long you will be separated from the ability to seek medical care, and how far away that medical care might be. This is more important in the third trimester, particularly in the late third trimester when labor is more likely. It’s for this reason that many cruise ships will not allow you to embark after 24 weeks’ gestation. They do not want any liability related to premature delivery when the baby has a chance to survive preterm. It’s not that sailing isn’t safe, it’s only that it is many hours away from a hospital.

Planes do not often limit travel by gestational age, but you should consider how long your flight is. There is a big difference between flying from Atlanta to New York versus flying from New York to Melbourne. In general, many doctors recommend avoiding flying after 35 weeks’ if the length of the flight is particularly long. Some people worry about traveling by car due to the concern of increased risk of blood clots secondary to the immobilization of sitting in a car. This is probably not a valid reason to avoid travel by car, particularly when you consider that pregnant women will be taking pit stops every two or three hours anyway. When you stop for a potty break, be sure to walk around for a couple of minutes.

Most itching in pregnancy is related to dry skin. A good lotion can go a long way in reducing or eliminating itching related to this problem. In some cases, itching confined to one area may be related to a reaction to something; we call this contact dermatitis. If you suspect this is the case, try to avoid whatever you came into contact with and think about any new lotions, detergents, or anything coming into contact with your skin or clothing. Consider using an antihistamine or an over-the-counter steroid cream to resolve the rash.

In rare cases, itching all over the body that is not associated with a rash can be due to intrahepatic cholestasis of pregnancy (ICP). ICP is an important diagnosis to not miss and your doctor may need to check some labs to make sure you don’t have this. If you do, she will prescribe medicine to improve the situation and she will likely deliver you a couple of weeks earlier than normal.

Lastly, if you have little red dots, plaques, or raised bumps that develop and are itchy during pregnancy, you may have polymorphic eruption of pregnancy (PEP). It most commonly shows up on the belly or legs. We treat this similarly to other rashes with topical steroid creams, antihistamines, or oral steroids if necessary, and soothing baths/lotions/loose clothing can help with the itchiness. When the itching gets really bad, trying cold ice packs to calm it down can be very helpful.

The answer to this question depends on how far along you are. If you are less than 20 weeks’ gestation or so, you are probably too early to feel any fetal movement. First time moms don’t typically report feeling movements (quickening) for the first time until 20 weeks or so; women who have had children before often feel the first movements two or three weeks sooner (around 17-20 weeks). Even after these gestational ages, it is still common to go a few days without feeling fetal movement until about 24 weeks or so.

After 24 weeks, you should expect to feel some movement every day, but how much movement you feel varies from pregnancy to pregnancy. You or your partner may not be able to feel the baby with a hand on the outside of your belly simply because you have an anterior placenta or the baby is turned and kicking in the other direction.

If you are concerned that you have not felt enough fetal movement and you are more than 24 weeks’ gestation, then lie down on your left side and concentrate on feeling for movements. You should feel at least six movements of some sort in the first hour; if you have felt some movements but not six, then continue counting for another hour. You should feel at least 10 movements during those two hours. Because of fetal sleep cycles, it’s not uncommon for it take two hours to feel the ten movements. Ideally, this is done during the baby’s active time. For many women, the baby’s active time is shortly after they have eaten dinner. So, maybe try eating a little something if you don’t reach the six kicks in an hour, and then extend to counting for the two hour mark. If you don’t reach 10 movements in two hours, then this is a reason to go to the hospital or office and be evaluated.

You might have read on the Internet that you should do “kick counts” every day. Most pregnant women do not need to do this as the practice may actually be harmful overall to the pregnancy. Only do daily kick counts if your doctor has told you to do it for a specific reason.

The short answer is no. Though there are a lot of products marketed to pregnant women who are willing to spend a lot of money to prevent stretch marks, none of them have good scientific data showing they work. Some products cite their own small studies, but they are usually poorly done or so small that it cannot be considered good evidence. Companies like to exploit new moms, so be leery. We don’t want that for you. Save your money. If your belly is dry and it feels good to use a nice lotion or other skincare product, go for it! But know that it will not prevent stretch marks. We promise the second we see something come out that is effective and has good data behind it, we’ll be the first to tell everyone.

Ah, the joys of pregnancy! If constipation, hemorrhoids, and heartburn weren’t enough to make you feel glorious, just wait until your legs start swelling.

Most swelling or edema in pregnancy is normal. Swelling is common; about 60% of women will have significant lower extremity swelling and a large number of these women will also have swelling in their hands that make rings too tight and wrists hurt. Much of the conventional wisdom about swelling during pregnancy is related to a concern for the development of preeclampsia, but swelling is so common that in most cases this is not a concern at all. Your doctor checks your blood pressure at your regular visits to make sure that you’re not developing hypertension, which is the chief sign of preeclampsia.

Most leg swelling is related to the uterus blocking the return of blood from your legs. As the uterus gets bigger, it blocks the veins that drain blood from the legs back up to the heart, and gravity doesn’t help with this process. Since there are no pumps in the legs, the blood tends to pool and this leads to swelling. You may be able to make this temporarily better by elevating your legs, particularly while laying on your side. But for most women who are up and working throughout the day, there is little opportunity for this. Wearing a pair of support hose, compression stockings, or compression socks may help tremendously.

If your hands are swelling, you may have symptoms of carpal tunnel syndrome which is also very common during pregnancy. Wearing an over-the-counter wrist splint at night on one or both wrists will lead to significant improvement of these painful symptoms.

One common myth about swelling is that a woman should drink more water when she is swelling to make the swelling better. This is simply untrue. If you’re having significant swelling in your legs, you may also find that you are lightheaded or having woozy episodes because your water content has left your blood vessels and gone into your soft tissues; in this case, drinking more water may help you not feel as dizzy, but it will not affect how swollen you are.

Back pain in pregnancy is almost universal. The bigger the belly, the more curved the spine, and the worse the back pain. As your center of gravity moves forward with your ever increasing belly size, your hips rotate forward, the curvature of your back changes, and the muscle groups you use to maintain your posture change. Because you are not used to using these muscle groups to stay upright, and because all of your muscles are doing more work than normal carrying around the extra weight, the result is chronic muscle strain, sprain, and fatigue.

Things to try include using acetaminophen to treat the pain and if you are less than 20 weeks’ gestation, you can still use nonsteroidal anti-inflammatories (NSAIDs) like ibuprofen or Naprosyn occasionally. A heating pad on the back, heat releasing patches, or a nice bath may also help a lot.

Exercise can help tremendously. Gymnasts and ballet dancers rarely complain of back pain during pregnancy because they have well-developed back musculature and core abdominal muscles. Exercises that help strengthen the back and core abdominal muscles can provide relief and prevent worsening problems as the pregnancy goes on. This includes things like Pilates or Yoga.

Many women benefit from wearing a back brace or pregnancy support belt (belly band). These devices tend to change your center of gravity slightly and help redistribute the load. Typically, these are most helpful in the third trimester. Even if you did not need one in your first pregnancy, keep in mind that during your second or third pregnancy you carry the baby differently in your pelvis and it may be beneficial this time around.

Massage can be beneficial and some women may need help from a physical therapist. Your doctor can let you know if physical therapy or, in some cases, pelvic floor physical therapy, might be appropriate for your symptoms. In some cases, we may prescribe muscle relaxants but these tend to be sedating. Still, they can be useful at night.

It’s unusual for back pain during pregnancy to require any testing or other treatments. However, if you have a history of chronic back pain or orthopedic abnormalities, be sure to tell your doctor or midwife. Various pains, particularly back pain, pelvic pain, and round ligament pain, are common in pregnancy.

Here is a list of things that can help relieve pains:

• Stretch and do strengthening exercises like Pilates or Yoga
• Wear a pregnancy support belt
• Use Tylenol
• Use warm compresses or pads
• Wear low-heeled shoes with good arch support
• Avoid lifting heavy items by yourself
• Elevate one foot on a support if you must stand for a long period of time
• Bend with your knees, not at the waist
• Try to sleep on your side with one or two pillows between your knees
• Place a board under your mattress to make your bed firmer

Women who are over 35-years-old at the time of delivery are considered to be of advanced maternal age (AMA). This label was created in the 1970s primarily because of the increasing risk of Down syndrome, which is 1 in 270 at age 35. This cut-off was picked many years ago because it was the expected pregnancy loss rate when genetic amniocentesis was performed; at the time invasive testing like amniocentesis was the only choice, and it made sense to only offer it to the highest risk women.

Today, we have non-invasive tests like NIPS available to screen for Down syndrome and we also know that the rate of pregnancy loss with genetic amniocentesis guided by ultrasound is dramatically lower than 1 in 270.

Apart from this increased risk of Down syndrome, being over 35 may not mean much of anything. Typically, as women get older, they may gain extra pounds and extra illnesses that would tend to complicate pregnancies. Yet, a healthy woman of normal body weight above age 35 who does not have a pregnancy complicated by Down syndrome should expect to have a better and safer pregnancy than a woman 10 years her junior who is obese or has a preexisting medical condition. So your doctor should individualize what your age means for you in the context of your total health status.

Here is the risk of Down syndrome by age and by trimester:

Here is the same risk expressed as number of cases per women at a given age:

Women today frequently delay childbearing until after age 35 and while this does increase their risk of miscarriage and conditions like Down syndrome, most have pregnancies whose outcomes are similar to those of younger women. It is also harder to get pregnant the older you get.

Down syndrome is the most common chromosomal abnormality affecting pregnancy, but there are many other chromosomal abnormalities, as well as thousands of genetic and structural abnormalities. Most of these are not detected with routine testing, including ultrasound.

Literally 97% of pregnant women complain of shortness of breath at some time during their pregnancies. Most of the time, this is related to some of the pulmonary physiologic changes of pregnancy that give women the sensation that they are not breathing in deeply or moving as much air with each inspiration, but their actual oxygen status remains unchanged. It is normal to feel as if you are not breathing as deeply or for your rate of respirations to increase with less vigorous activity while pregnant.

Rarely, difficulty breathing is a sign of a more serious problem. If you’re having trouble catching your breath even while resting or if you have symptoms of low oxygen levels, like changes in the color of your skin or confusion, then you may need to seek medical care immediately. Women who have underlying asthma may also have shortness of breath related to uncontrolled asthma during pregnancy and this would be a reason to seek immediate medical attention. Also, if you notice that you can’t sleep without propping your head up with several pillows, you need to talk to your doctor.

Otherwise, if your shortness of breath is just with exertion and becomes improved with rest, this is likely normal.

Yes.

It is a myth, sometimes perpetuated by massage therapists themselves, that massages can be so relaxing that they might stimulate preterm labor. This is completely untrue. Some massage therapists may want a note from your doctor stating that a massage is safe, and we can’t think of a good reason why your doctor wouldn’t give you such a note.

Pregnancy is good and bad for headaches.

The good news is, migraine headaches are uncommon during pregnancy. Most chronic migraineurs thoroughly enjoy pregnancy because it is one of the few times in their lives when they don’t suffer from migraine headaches.

The bad news is, other types of headaches, particularly tension headaches, can become more common during pregnancy with the musculoskeletal strains, tensions, anxieties, and stresses associated with pregnancy.

You can always use acetaminophen at any time during pregnancy for headache. If you’re less than 20 weeks’ gestation, you can still use ibuprofen or Naprosyn. Other medications like Excedrin Migraine can also be used on a limited basis. A good massage, a relaxing bath, or just a good night’s rest may be the cure for a tension headache.

Sometimes headaches have other causes, like sinus infections or allergies. If you suspect that your sinuses are the problem, try an over-the-counter antihistamine and if this doesn’t work, talk to your doctor.

Some women have caffeine withdrawal headaches, especially in the first trimester. These headaches are all too common if you have recently cut out all caffeine because you’re pregnant. Remember that you can have up to 350 mg of caffeine per day. You may need to add a little bit of caffeine back in order to prevent headaches. Caffeine is also a treatment for some tension headaches as well. Taking your acetaminophen with a serving of caffeine may be just what the doctor ordered.

At your first visit, review medications that you regularly take with your doctor, even over-the-counter medications, including herbals and supplements.

Sometimes you will have a problem develop during pregnancy and you'll wonder if you can take an over-the-counter medicine or remedy. Click here for a list of acceptable drugs. If you don't see what you're interested in on the list, check with your doctor.

A lot of women ask this question because they’ve been told to never sleep on their backs, particularly in the third trimester. Most advice on the Internet and in books about pregnancy recommends against sleeping on your back. There is no good scientific evidence that sleeping on the back increases the risk of stillbirth, even in the third trimester. There have been studies that show that fetuses have some fetal heart rate changes in different sleep patterns while the mother is sleeping on her back, but these changes have not been definitively associated with an increased risk of stillbirth. Studies of observed sleeping habits show that women roll around a lot and likely have little control how they lie during sleep.

Women in the third trimester are unlikely to sleep on their backs naturally due to their belly size, so they will tend to sleep on one side or the other anyway. If they do sleep on their backs, there is little to do about it since women have no control over how they turn and roll during sleep. Since there has been no definitive connection between back sleeping and stillbirth, women should not lose too much sleep (pun intended) worrying about how they sleep.

Yes, please do.Good dental hygiene is associated with good pregnancy outcomes. A severely infected tooth, on the other hand, may lead to problems for the pregnancy. There are no routine practices at the dentist’s office that are unsafe during pregnancy. This includes pulling teeth and getting dental x-rays. A pregnant woman can undergo many tens of thousands of shielded dental x-rays during pregnancy without fear of delivering a harmful amount of radiation exposure to the pregnancy.

Local anesthetics, antibiotics, and pain medicines that are commonly used by dentists are all also safe during pregnancy. If your dentist has a question about a particular antibiotic or other medicine, have them ask your doctor.

Sex is safe during pregnancy and often a lot of fun. Most couples enjoy the body’s changes during pregnancy, but sometimes women can find sex painful and problematic.

Some women find it difficult to relax because they’re worried that sex may be harmful to the pregnancy; this is an unnecessary fear – sex is not associated with any negative outcomes during pregnancy. Most of the time discomfort and pain during sex is just related to your changing anatomy and body shape. Familiar positions may become uncomfortable because your belly is in the way and more penetrating positions may become less desirable because your uterus has started to take space away from the upper part of your vagina. Usually, a little creativity can be both fun and problem-solving. Rear vaginal-entry positions, with the help of a few pillows or a wedge cushion, can solve several problems at once. The woman on top, as long as it’s not too penetrating, can also be pleasurable for both and it can allow you to determine the angle of entry and the depth of penetration to a degree. Finally, if you lay on your side and draw your top leg upwards, this can allow your partner to straddle your bottom leg and enter at a 90° angle from the normal. This side saddle approach allows for complete control over the angle of entry and allows you to control the depth of penetration with your top leg.

Unfortunately, acne tends to get worse during pregnancy. Blame your hormones and your beautiful, oily glow of pregnancy. Still, there are a few things you can do. It is safe to wash your face with benzoyl peroxide during pregnancy. Benzoyl peroxide is the common ingredient in most over-the-counter acne remedies. Check the label.

If you wash your face at night and then go and lay down on your pillow from last night, you may find that you have re-contaminated your face with last night’s oils and bacteria. One evidence-based trick is to place a fresh, clean towelette over your pillow each night that you remove in the morning. This towelette can collect the new nightly skin oils and bacteria and not allow them to saturate into your pillow and pillowcase. Just change it each night. Oral retinoids (e.g., Accutane) should be avoided during pregnancy due to the severity of birth defects that a fetus may develop as a result of exposure. Many other acne treatments are not safe during pregnancy. Ask your doctor before trying any other remedies.

Oral retinoids (e.g., Accutane) should be avoided during pregnancy due to the severity of birth defects that a fetus may develop as a result of exposure. Many other acne treatments are not safe during pregnancy. Ask your doctor before trying any other remedies.

Due to some of the physiological changes of pregnancy, it is common for women’s resting heart rate to be about 10 to 15 beats per minute faster while pregnant. Pregnant women are also more likely to have bigger increases in their heart rate with exertion since they are doing more work while pregnant. This increased work starts even in the first trimester, as pregnant women have a blood volume expansion of over 40%. It doesn’t stop there, as pregnant women also do more work, moving around an extra 30 pounds or more in the third trimester.

As the uterus gets larger, the heart is pushed upwards and rotated to the left. This changing position of the heart allows women to become more aware of their heart beating and sometimes this is alarming because they don’t normally perceive that their heart is beating in their chest. Couple this with the fact that the heart may be beating faster than normal, then this can be quite anxiety-provoking. But if your heart rate isn’t too fast at rest and you don’t notice that it is beating irregularly, don’t worry too much. If you feel like your heart rhythm is irregular or your heart rate is persistently fast and staying that way, talk to your doctor.

Yes! There are some rare reasons for a woman to abstain from sex during pregnancy. These rare cases where the risks may outweigh the benefits include certain cases of preterm labor with advanced cervical dilation; preterm, premature rupture of membranes; or placenta or vasa previa. Also, women who have had a cervical cerclage during pregnancy should probably abstain. Otherwise, have fun!

Most women find sex during pregnancy more satisfying and pleasurable than outside of pregnancy. Sex during pregnancy is not associated with an increased risk of miscarriage, preterm labor, or any other complications of pregnancy. Even in cases where penetration may not be the best idea, such as the situations listed above, orgasms during pregnancy are still perfectly fine. If you have a cervical cerclage and don’t need penetration to orgasm, then feel free to have fun!

As your uterus gets bigger during pregnancy, different sexual positions may help both with comfort and satisfaction. If you are having trouble with comfort during sex, ask your doctor about it.

If you failed your 1-hour glucose screen AND your 3-hour glucose tolerance test, then you have gestational diabetes.

Hopefully, you’ll get a chance to talk to a dietitian. In the meantime, try to cut down (if you can, cut them out completely) the simple sugary items from your diet: sodas, cookies, cakes, candies, and other sources of sugary carbs. Paying attention to portion size is the best thing you can do. Try to make your plate ½ greens, ¼ grains, and ¼ protein for every meal. If you’re not already, add in four to five 20 minute walks or other cardiovascular exercise sessions per week.

You’ll need to check your blood sugar several times per day, at least initially. You should check your blood sugar first thing in the morning (a fasting blood glucose), and then check it two hours after each large meal – breakfast, lunch, and dinner. Your fasting blood sugars should be below 95 and your blood sugars after meals should be below 120. If your blood sugars are running higher than this, you may need to take medicine to help lower your blood sugars.

Is also helpful, in the beginning at least, to track what you are eating. This can help your dietitian and your doctor decide if there are some things you should do differently in your diet. It can also help you understand why your blood sugar might spike – for example, after delicious pizza.

Yes!

The Internet is full of advice recommending that you don’t dye your hair while pregnant, at least in the first trimester. This is born out of ignorance and a fear of everything during the first trimester. There is no scientific data that says that dying your hair is associated with any adverse problems, even in the first trimester. If you think about it, most female beauticians and hair stylists also become pregnant at some time, and they are exposed to these chemicals hundreds or thousands of times more than what you are exposed to when getting your hair dyed. We don’t recommend to those women that they should change their occupation while pregnant.

Yes!

Because of high levels of mercury in some big fish, pregnant women should avoid shark, swordfish, king mackerel, and tilefish. Smaller fish are usually safe, such as light tuna, salmon, pollock, and catfish. Up to 12 ounces per week of these fish is considered safe.

In fact, regular consumption of fish (and their omega fats) has been associated with lower rates of preterm labor and other complications of pregnancy. Recent evidence suggests that even the recommendation about avoiding the larger fish is likely unnecessary. So don’t stress too much unless you happen to eat these larger fish multiples times per week.

Probably. Pregnant women have more vaginal discharge than nonpregnant women. It is common for pregnant women to wear a panty liner while pregnant because of this discharge. Most of this discharge is physiologic and represents cervical mucus. The more babies you’ve had, the more likely you are to experience this discharge. If your discharge has a bad odor, itches, or is green in color, tell your doctor to make sure it’s not an infection. Otherwise, expect to have some discharge throughout pregnancy.

Nobody likes a hemorrhoid. Hemorrhoids don’t even like hemorrhoids. Unfortunately, they are common during pregnancy and become more common in the third trimester. All of the normal over-the-counter remedies for hemorrhoids are perfectly fine to use while pregnant, including Preparation H and Anusol-HC. Tucks pads, which are pads infused with witch hazel, are also effective. Many women will use the pads in combination with one of the creams.

Most hemorrhoids get significantly better after delivery, though they may get worse with pushing. Sitz baths with added witch hazel may be your best friend in the postpartum period.

Rarely, hemorrhoids become thrombosed and need to be dealt with surgically as an emergency. You should suspect that a hemorrhoid has become thrombosed if you have new, different severe pain that prevents you from being able to sit down. If you’re worried about this, ask your doctor immediately.

Yes!The best way to protect your baby during pregnancy is to protect yourself. Seatbelts are the best way to do this while driving. It is a myth that seat belts add extra or unnecessary risks to your baby; on the contrary, they may save your life and your baby’s life.Buckle up!

Well, you’ll think we’re biased for saying it, but the answer is no. While birth can be and usually is a very benign event, the truth is that the safest place for you to deliver your baby is in a hospital. It is the safest option for your and your baby’s health, in case anything were to go wrong. We cannot completely predict who will have issues at the time of delivery, or leading up to it. We know of certain risk factors that increase the chance of serious events happening, but ultimately, a number of things could happen to even the healthiest people. 

The biggest risk factor for issues at delivery, believe it or not, is being nulliparous (a woman who has not delivered a child before). The reasoning behind this is because we do not know if you have an adequate pelvis for childbirth and you are at the greatest risk for shoulder dystocia and stalled labor. In the next section, we discuss some complications that can arise during pregnancy. One thing that all of these complications have in common is that the quicker we identify them and come up with a plan to treat them, the better it is for you and baby. That identification and treatment is best facilitated if you are in a hospital under the care of nurses and physicians that can monitor for these things. 

The bottom line is that studies consistently show that even with low-risk and well-selected patients, home birth is consistently more dangerous for mom and baby.

The reality of cord blood banking is that it is a huge expense for little to no benefit for the average person. Private cord blood banking has an initial collection fee anywhere from $1,000-$2,000 and then an annual storage fee that can be around $200 per year depending on the bank. Cord blood contains stem cells that can be beneficial in the treatment of different blood and bone marrow disorders. If there is a family history of a disease with a known genetic component, then there may be an argument to storing it, but not everyone has the money and not every disease can be predicted so you have to weigh the risks and benefits for your situation. 

There is very little research involving stem cell therapies that involve using blood from umbilical cords and there is a real concern over how many stem cells can be retrieved from these frozen samples after a few years in the freezer. It is questionable if any child so far as ever benefited from having cord blood frozen, so it’s probably best to keep it limited to a few rare situations involving some rather rare diseases as part of a research protocol

The most effective pushing is usually done when you take in a deep breath, fill up your lungs, and then hold that air in while you bear down, tuck your chin to your chest, and push as hard as you can into your bottom. We encourage you to hold those breaths for 10 seconds and attempt two to three rounds of 10 seconds of pushing if the contraction allows it and you are able. Typically, the moms that scream or let the air out tend to have less effective pushing but sometimes that’s okay! The lungs filled with air push the diaphragm down, increasing your internal abdominal pressure which helps with the pushing and contraction combined. Still, feel free to scream, cry, or do whatever you need to do to get through it. No one is judging you. The reality is, labor can be a long process, and your doctor can give you feedback on what pushing methods you should try to yield the best results.

The position you’re in while pushing can vary widely. When you lay on your back and pull your legs back, MRI studies have shown that this creates the most space for the baby. That is not what is commonly claimed by a lot of birth advocates who argue for pushing while squatting or in some other upright position. However, those positions tend to put pressure on the lateral sides of the pelvis (at your hips) and make the pelvis wider but narrower from front to back, which is where it really matters.

The truth is, women should be allowed to push in whatever position they are most comfortable and different positions will provide different degrees of pain relief for different women. We will help you know if your pushing is effective and if you might be better served in a different position.

Many women will sometimes pass a large plug of mucus (and maybe some blood) at some point during cervical dilation. As the cervix dilates and thins, the mucus buildup that was there in the cervical canal can come out. It has also been called “the bloody show” if its blood tinged. Losing this plug doesn’t actually have any diagnostic or predictive value for us as doctors. Many people think “it’s go time” when they lose it or that they are going to progress faster after its expulsion. Unfortunately, women can start to dilate a small amount early and lose it even weeks before they actually go into labor. Sorry to disappoint you, but the baby is going to come when the baby is going to come. 

You might, but don’t worry about it. We are all used to it and completely unfazed by it. If you ask us if you did, we will probably lie to you and say no (the only lie you will hear from us, we promise). The reality is that you have a big head pushing down right against your rectum while you’re pushing. In fact, we tell you that the pushing you do to deliver the baby should feel like “the biggest poop of your life,” because you are directing all that pressure down towards your bottom. If it happens, then you’re pushing in the right spot! It will be wiped away and no one will have a second thought about it.

Cervical checks can vary based on institution. It is definitely true that more cervical checks lead to an increased risk of infection. That being said, some checks are necessary to determine labor progress. We can optimize the risk/benefit ratio. Checking every two hours is common in some practices but is usually not necessary. In the latent phase of labor, from 0-6 cm, checking every X amount of hours is not necessary. If you are being induced and you have a cervical ripening agent in, like a cervical medication or a catheter balloon, then at the time of placement you are checked and the next check should occur when a decision is being made: for example, do you need another dose of medication or can the catheter be removed? This may be many hours (usually at least four hours).

How often the cervix is checked should be based on patient feedback (feeling more pressure, contractions getting stronger/closer together, etc.), and no more often than every four hours usually in latent labor. Even in active labor, from 6-10 cm, we don’t worry about “failure to progress” until four hours of no cervical change. Therefore, we can check at four hours and usually still have all of the information necessary to determine if something should be done about slow labors.  Remember, sometimes there is a good reason to check more often, especially if you get towards the end and continue to feel a lot of pressure or even begin feeling the urge to push. We want to check you as few times as necessary while still making sure we can monitor your progress.

After the baby is born, there should be a pause before clamping the cord (as opposed to immediately clamping it). This is called delayed cord clamping or optimal cord clamping. The baby is placed on your chest/belly depending on the length of the cord and as long as the baby appears healthy, your doctor will wait at least 60 seconds OR until the baby gets their first good cry before clamping and cutting the cord and detaching the baby from the placenta. Studies have shown that at least 60 seconds is optimal, but longer than that is okay as well. The baby can get an additional 80 mL of blood during this time. The extra blood has been shown to improve hemoglobin and iron stores within the first year of life, and improve cognitive, motor, and behavioral development. After this, the doctor will clamp the cord and hand someone of your choosing the scissors to cut the cord. Then, while you pay attention to your new baby, the placenta will be delivered with gentle traction and you will no longer be pregnant!

Delayed cord clamping is the standard of care and has been for several years.

Perineal massage a few weeks leading up to delivery may decrease the chance that you tear, but it does so by causing unwanted (and permanent) relaxation of the vaginal tissues. It isn’t worth it. During labor, your doctor or midwife may provide some slight pressure on the perineum while you are complete and pushing. This can be seen as a massage, but in reality we are just helping to slowly stretch some of those muscles in the pelvic floor as the head begins to descend. This encourages the tissues to relax rather than contract right back after a contraction and push the baby back after the progress you just made with your pushing. At the actual moment of crowning of the baby’s head, studies have shown that a grip of the perineal tissues (applying counterpressure to the stretch of those tissues) can help prevent significant tears at the time the head delivers out of the vagina, the moment when most tears occur.

There’s no reason to check your cervix unless you’re having signs of labor, like regular contractions, or bleeding or leakage of fluid. If you’re considering an induction, checking your cervix might help determine how good the idea might be. If your cervix isn’t ready for labor (not dilated at all), then an induction might unnecessarily increase your chances of a Cesarean delivery.

Yes. Especially if you’ve already had children, you might notice that your milk comes in early or that you have occasional leakage, even in the first trimester. Even if you haven’t had a baby yet, it’s not uncommon at all for you to leak some milk. If this is a persistent problem (or an embarrassing one), you might need to change up your bra or wear nipple shields so that your nipples are less stimulated.

Inductions happen for lots of good reasons – but also some not so good ones. Unless there’s a medical reason to do so, you shouldn’t be induced before 39 weeks’ gestation. Even at 39 weeks, induction might not be the best idea unless your body is ready for labor. Checking your cervix can help determine this. Otherwise, it might be better to wait until 41 weeks. After 41 weeks’ gestation, it’s unusual that going any further makes much sense due to increasing risks for the baby and no benefit to the mother in terms of decreased Cesarean rate (in fact, the risk of Cesarean actually goes up for most women after 41 weeks).

Sometimes you might need to be induced much earlier, but it should be because you have a medical problem like high blood pressure or some other complication.

Yes! You should definitely immunize your baby. There are a few very specific conditions when a baby shouldn’t get immunizations, and if that’s the case, your pediatrician will let you know. That is rarely the case, however, so immunize your baby. Thousands of studies have examined the safety of giving multiple vaccines at once with the overwhelming conclusion that it is safe and does not “overwhelm” a baby’s immune system. On-time vaccinating also ensures that babies have adequate protection against diseases as early as possible. Practically speaking, giving more than one vaccine at a time minimizes office visits, simplifies parents’ lives, spares babies extra visits for pokes, and saves you from multiple trips in the waiting room where others may be sick! For more in-depth information online, see healthychildren.org, vaccine safety section. Most importantly, ask your baby’s pediatrician if you have questions!

Yes!

Breastfeeding is not the panacea that some people make it out to be, but it is the best thing for your baby if you are able to do it. Breastfeeding is associated with fewer newborn infections, better maternal-infant bonding, lower cost, and greater convenience. There are only a very few reasons why a mother should not attempt to breastfeed, and the vast majority of women who attempt to breastfeed will be successful. HIV was previously one of the most common reasons to not breastfeed, but a recent study states that people diagnosed with HIV who meet certain criteria should be supported if they want to attempt to breastfeed. Criteria that should be met include starting antiretroviral therapy (ART) before or early in pregnancy, maintaining viral suppression, and being committed to taking ART while breastfeeding.

That being said, we acknowledge that sometimes it can be a difficult feat and some babies have a hard time with it. Talk to your doctor if you’re struggling, find a good lactation consultant, and be persistent. If at first you don’t succeed, try again! It can take babies and moms a while to get used to the process.

Also, the old saying “breast is best” may be true, but the rest of that saying is “but follow with the bottle.” If in the beginning you are not producing milk or only producing a small amount and baby is still visibly hungry after the breast, give them the bottle. But at the next feed start with the breast again! The truth is, fed is best and whatever is needed to help your baby grow is what you should do.

If you have tried breastfeeding, done the consultations, worked with the baby and tried the tips and tricks but it still isn’t working, that’s okay! Your baby and you will be okay and it is okay to turn to bottle feeding primarily. You tried your best and you should never feel bad about that. Sometimes it just doesn’t work out.

No! Except in some very rare emergency cases, episiotomies should never be performed. If your doctor performs routine or frequent episiotomies, then he may not be practicing up-to-date medicine. We have known since the mid-1980s that episiotomies are harmful and unnecessary except in a handful of rare emergencies, such as severe shoulder dystocia.

This doesn’t mean that you might not tear, but however badly you might tear, an episiotomy likely would have made things much worse.

No! Alcohol does pass easily into breastmilk, but it’s also absorbed from milk much like it is from the bloodstream. Basically, if you are sober enough to drive, you’re likely sober enough to breastfeed. A rough average is about two to three hours after one drink. If you breastfeed a little early, it’s unlikely the baby will receive enough to be harmful. Only a very small percentage is actually passed on to the baby in breastmilk. Of course, if you had more than one or two drinks and will need to wait longer than usual between feeds, pumping and dumping may make you more comfortable! Also, bear in mind that current research suggests that “moderate” alcohol use (generally meaning less than one drink per day) is not considered harmful to babies. More than that and you could be putting baby at risk; there is no known “safe” amount of alcohol in breastmilk, and some research suggests frequent alcohol use during breastfeeding may put babies at risk for slowed development and poor weight gain.

A lot! Newborns sleep up to 17 hours a day. Eventually this will be in longer sessions, but sleep cycles are not regular until about six months, so expect “naps” of one to two hours which gradually lengthen as the baby becomes more regulated. By the end of the first year, most children will sleep 11-15 hours a night.

Generally, breastfed babies eat every two to three hours, and babies taking formula eat every three to four hours. For the first several months, babies shouldn’t go much longer than four hours without eating, since they don’t have enough stored sugar to “fast” longer than that. Little ones tend to show you they’re full by turning away, becoming distracted from feeding, or simply falling asleep. If the baby is still fussing or smacking her lips at the end of a bottle or breast, she’s probably still hungry. Babies getting enough to eat will generally have one wet diaper for each day of life up to a week of age, then will level off at six to seven wet diapers and (on average) three to four dirty diapers each day. The doctor will measure the baby’s weight at each check-up; appropriate weight gain (typically 20-30 grams per day for newborns) is another good indication that the baby is getting enough to eat.

Honestly, don’t worry about it too much! Just keep it clean and dry – so if the baby needs a bath while the cord is still attached, sponge-bathe rather than submerge the baby. Another trick is to fold down the top of the diaper before fastening; this keeps the cord from being irritated and helps keep it dry. If the cord becomes dirty, just use soap and warm water to clean it; no need to use alcohol or other agents. If you notice any discharge from the cord (particularly if it smells bad), bleeding more than a few drops, or if the baby cries when you touch or move the cord, let the doctor know. Cords usually fall off by several weeks of life; if it’s still present at eight weeks or so, bring it to your pediatrician’s attention.

Pretty much whenever they get stinky! As long as you clean the diaper area well during diaper changes, babies only need baths a few times a week on average. Bathing too often can lead to dry skin, so pat the skin dry and make liberal use of hypoallergenic, fragrance-free lotion after baths.

We’re still unsure exactly what makes SIDS (sudden infant death syndrome) occur, but the best research we have suggests the best way to keep a baby safe is to place her on her back during sleep until her first birthday. This should be on a firm sleep surface, free of any loose or soft objects (including blankets, stuffed animals, pillows, crib bumpers, etc.), and ideally in the parents’ room until the baby is at least six months old. Avoid placing babies to sleep on couches, armchairs, or other soft surfaces. If you are holding a baby and start to fall asleep yourself, it’s safest to put the baby down in a safe place, ideally as soon as you feel sleepy but definitely as soon as you wake up. Research also suggests that breastfeeding babies until six months as well as pacifier use during sleep can help reduce SIDS risk. Maternal smoking is an independent risk factor for SIDS in infants. No recommendations can be made for bedside or in-bed sleepers, and bed-sharing is NOT recommended for any infant.

The safest sleep environment for a baby can be remembered by “ABC” – Alone, on their Back, and in a Crib. To elaborate, this means babies are safest in a flat crib (or similarly firm sleeping surface) with only a fitted sheet – no pillows, stuffed animals, crib bumpers, fluffy blankets, extra humans, etc. A wearable blanket, sleep sack, or thin blanket swaddled around the baby is okay.

Early on, it’s not unusual for babies to be awake as much at night as they are during the day; they often don’t start to sleep in longer spurts through the night until one month or so. So until then, time and patience! Afterwards, if the baby is having trouble with night-day reversal, it can help to have more “active” sleep during the day – not worrying if there’s background noise, lights on, etc. At night, the goal should be for very calming interactions – dark room, minimal noise, low-volume speech. Most babies are getting two-thirds of their daily sleep at night by three months.

Circumcision practices vary widely due to different cultural and religious expectations that exist. Medical groups around the world that discuss circumcision acknowledge the same facts surrounding circumcision, but they highlight some aspects for and against circumcision differently to either encourage, discourage, or remain neutral about the practice. Some facts are more relevant in other countries than in the United States; for example, the local rate of HIV infection will make circumcision more or less valuable.

Here we will list evidence-based statements surrounding circumcision in a neutral manner and allow you to draw your own conclusions.

• Circumcision is associated with a lower risk of HIV transmission in HIV endemic locations like Africa. In the U.S., the overall incidence of HIV is so low that circumcision has yet to show a protective benefit, even in populations that are more at risk for HIV, such as men who have sex with men.
• Circumcision is protective against invasive penile cancer. However, the rate of penile cancer in the U.S. is 1/100,000 men.
  • 50% of those penile cancers are caused by HPV 16 and 18, similarly to cervical cancers. We now vaccinate against those subtypes with the GARDASIL vaccine.

  • Widespread adopted vaccination with GARDASIL would provide a more protective benefit against penile cancers as well as reduction in smoking and proper hygienic practices.

• 3% of uncircumcised males will get a urinary tract infection (UTI) compared to about 1% of baby girls and circumcised boys. Circumcision only reduces the risk during the first year of life and most UTIs are easily treatable.
• Circumcision of males does reduce the risk of transmitting certain infections to female partners: HPV (a cause of cervical cancer), herpes, chlamydia, and syphilis.
• Phimosis occurs when the skin around the glans penis becomes scarred/swollen/painful and is unable to retract. This can occur in about 1% of uncircumcised males. There are also cases of phimosis occurring in circumcised males due to the scarring from the procedure (mainly the Gomco clamp method); however, the true incidence of this is unknown. There are multiple steps that males can take to reduce their risk of phimosis – whether circumcised or uncircumcised. The cure for phimosis is circumcision.

Known risks of circumcision include: bleeding, infection, need for repeat surgery, meatal stenosis, and partial loss of penis.

There is no quality evidence that circumcision reduces sexual pleasure. Newborns, of course, cannot directly consent to receiving circumcision, though this is true of many things and parents ultimately have a duty and right to make decisions on behalf of their children that involve their health or safety.

A lot of the claims of benefit and harm regarding circumcision are exaggerated. Most men in the world are not circumcised. The CDC states that in 2010 in the U.S., 58.3% of men were circumcised, and in first world countries, we don’t really see significant health differences. Obviously, you may have a religious preference for circumcision. Discuss these issues with your doctor for and make a decision you feel is best for you and your son.

First of all, a few normal things: some swelling is expected and there may be small amounts of blood on the first few diapers. If it’s more than about the size of a quarter, let your pediatrician know. It’s also very normal for a yellowish layer to form over the glans – this is known as granulation tissue and is part of the healing process. The best thing to do in the first few days is lube, lube, lube!  Use liberal amounts of petroleum jelly (Vaseline) or a water-based lubricant (i.e., K-Y) over the circumcision with every diaper change to prevent friction. Gauze may be used over the tip of the penis for the first day or two, but make sure not to wrap gauze all the way around the penis itself as this could become constrictive with any additional swelling that develops. If the penis becomes soiled, clean gently with soap and water; anything more (alcohol wipes, etc.) is generally too harsh and drying. The glans typically heals fully in 7-10 days.

You're not alone. Most women struggle at some point with breastfeeding. Click here to read our primer on breastfeeding and if you still having questions afterwards, ask your doctor or lactation consultant.

The good thing is, there are a lot of birthmarks and rashes that babies get, and only a small amount of those are scary! Milia and neonatal acne are commonly seen on baby’s face and will improve on their own. A splotchy red rash may be erythema toxicum neonatorum (baby acne) in the first few days of life, or may be a heat rash if the baby was a little over-bundled. Importantly, a blistering rash (i.e., fluid-filled bubbles) might be a number of normal or benign conditions but also could be a sign of infection you should have checked out by a doctor.

Check out this website for images and descriptions, as well as red flag symptoms of a rash that should send you to the doctor if you see them.

Jaundice causes the skin to appear more yellow, usually starting in the face then spreading to the chest, abdomen, and limbs. It can also cause the whites of the eyes to appear yellow. If the baby is appearing more yellow than her last check-up, you notice that her belly, arms, or legs are yellow, or if her eyes are yellow, talk to her pediatrician, especially if she is acting more fussy, eating less, or harder to wake up.

Totally, especially in the first few weeks. Depending on if the baby is breast or bottle fed, stools can be greenish-yellow to brown or tan in color, and loose and seedy to peanut butter consistency. Colors poop should NOT be are black, with visible blood, or white and chalk-like. If they are, talk to your baby’s doctor!

If you made sure all of their needs are met (clean diaper, fed, attempted a nap), you might check the temperature to make sure the baby doesn’t have a fever. You can also check to make sure the baby doesn’t have any hair or string caught around small body parts (fingers, toes, or penis; these are called “hair tourniquets”). If you’ve done all of this and haven’t found anything out of the ordinary, try swaddling the baby, rocking her or walking with her, offering a pacifier or her thumb/finger to suck, or turning on soothing sounds (soft music or white noise, like a fan). If you’ve tried all of these things and she is still upset, it is okay to put the baby in a safe place and take a break, especially if you feel yourself getting frustrated. Give it ten to fifteen minutes (or longer if you still feel upset), then try soothing measures again. If crying persists no matter what you do, it might be time to call the doctor’s office.

There’s no quality scientific evidence that suggests that this is beneficial. Some women who are anxious about breastfeeding may gain confidence by doing this, but just as many women suffer pain, frustration, and unnecessary anxiety by attempting to hand express before the baby is born. The highest quality studies have found no health benefits to baby from having colostrum or milk already available by birth.

The best way to stop breastfeeding is to wean the baby and yourself from the process, rather than stopping suddenly. Stopping abruptly can cause your breasts to get painfully engorged or infected, and the baby may be fussy or not tolerate switching from the breast to bottle or solid food depending on their age. The best way to wean is to start either by shortening feed times, or substituting a feed per day with an alternative (bottle or food). 

If your breasts are painful during this time, you may want to relieve them by hand expressing a small amount. Pumping instead of feeding will still feedback to your brain to produce milk, so if you must express or pump, do so very minimally so things can wind down. Ibuprofen, cold compresses, and tight bras can all help you during this process.

If one or both of your breasts is red, tender, warm to the touch, and swollen persistently then the answer is probably yes. You may experience burning or pain when the baby is feeding as well. Mastitis is inflammation of the breast that may or may not have a concurrent infection. Most commonly, fissures or cracks in the nipple allow bacteria to enter the milk ducts and cause problems for mom. Usually we recommend that during time between feeds you do warm and cold compresses, use Aquaphor or a lubricating agent on the nipple (even dabbing your own milk on the nipple can hydrate the dry skin), and take some ibuprofen or Tylenol. If this does not get better over the next few days or your doctor suspects a concurrent infection, they can prescribe an oral antibiotic that is safe to take while breastfeeding. You can and should still breastfeed with mastitis because it is safe for baby and can reduce the risk of the mastitis developing into an abscess.

We hope not! But some women do, of course.

Cesarean delivery is definitely over-used in the United States. There are some good reasons why a woman might need one:

• If she has had a prior “classical” Cesarean delivery (where the incision on the uterus is made higher than normal)
• If she has had more than two prior regular (“low transverse” incision) Cesareans
• If she has placenta previa, where the placenta covers (or is very close to) the cervix or vasa previa (where placental blood vessels cover the cervix)
• If her baby is breech or sideways (and the doctor is unable to turn the baby to be head down)
• If her baby does not tolerate labor (this should be relatively rare and there are some specific criteria that can indicate this)
• If her baby is too big, which is more than 5,000 grams (or about 11 lbs) for a nondiabetic mother or more than 4,500 grams (or just under 9 lbs 15 oz) for a diabetic mother
• If her labor doesn’t progress or she is unable to push the baby out after sufficient time (many doctors don’t give women enough time for these things; however, we have criteria that we follow to determine if this is happening)
• If she has triplets or quadruplets, or monochorionic-monoamniotic twins
• If she has active genital herpes or uncontrolled HIV

Those are just about all of the reasons, aside from the more emergent ones we won’t go into here. We don’t know for sure, but as many as half of all Cesareans performed are unnecessary. Most of the unnecessary Cesareans are related to impatience. Guidelines from the American College of Obstetricians and Gynecologists (ACOG) will, if followed, result in significantly fewer Cesareans if doctors follow them.

Probably not. This is a trick question, though. You have to separate out laboring in the water and actually giving birth in water. Most of the known advantages of water birth are actually related to the process of laboring in water while the known disadvantages of water birth are associated with giving birth in the water.

For example, the benefits of reduced pain during the first stage of labor (that is, the part leading up to pushing), a shorter first stage of labor, and less need for anesthesia all occur before the birth itself takes place. At the same time, the reported disadvantages of a water birth all take place during the actual process of delivery, including newborn aspiration, drowning, infections, hyponatremia, depressed Apgar scores, and umbilical cord rupture. So, it probably makes the most sense to labor in the water and then get out when it’s time to push and have the baby on dry land.

If you think about it, nature designed the birth process to happen on dry land. One of the benefits of a vaginal delivery compared to a Cesarean delivery is that the baby gets most of the amniotic fluid squeezed out of her lungs while traveling through the birth canal so that her first breath, once delivered, is full of nice, clean air. This doesn’t always happen with a Cesarean delivery and, consequently, babies have higher rates of respiratory problems with Cesarean birth as compared to vaginal birth. In any event, when a baby is born vaginally underwater, the first inspiration by the baby may be underwater and therefore lead to aspiration of water with subsequent increased risk of infections, drowning, and other respiratory problems. Keep these things in mind when you read about water births being more natural than land births. There’s nothing natural about it at all. In fact, water births are a rather modern invention. Currently, the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists recommend against deliveries occurring underwater.

If you’ve had a previous Cesarean delivery (or two), you may be a candidate for a trial of labor after Cesarean (TOLAC). This is a complicated issue. The short answer is that most women with only one prior cesarean delivery should try VBAC (vaginal birth after Cesarean), but you should read more about it here.

It depends. Although we classically tell women to wait six weeks after delivery to resume sex, many do not and there isn’t really any science behind this advice. The actual answer varies by woman, and likely depends on how you delivered (vaginally or Cesarean), if you had problems (a bad tear or no tear), and whether you have the energy and interest.

Here are some things you should know:

• If you aren’t lactating, you will probably ovulate again about 25 days after delivery. This means you could get pregnant from sex that happens as early as three weeks after delivery. Since the time of return to ovulation is variable from person to person, just assume that you are fertile any time after two weeks or so postpartum.
• If you are breastfeeding, you probably won’t ovulate in the first six weeks, but you SHOULD NOT count on this. Many women have gotten pregnant while breastfeeding.
• If you had a vaginal delivery with a tear, you may need four weeks or longer to heal before sex is comfortable (and sometimes much longer if the tear was severe or it’s not healing well).

So when should you have sex? When you feel like it and when you feel healed; but make sure you use birth control or you might have two babies in the same year! Many women have sex before their six weeks postpartum check-up and most of those women have sex the first time at three to four weeks after delivery. It’s really up to how you feel. It is also very normal to not want to have sex for a while and that is okay too. New babies take a lot of time and most new moms find sleep more appealing that sex!

Many women are sure they are done having children and want to know if they should get sterilized. There are many sterilization procedures, and you often can get sterilized right after delivery or the next day, at the time of a Cesarean delivery, or a few weeks after delivery. Women can get their tubes tied through a small incision in their belly button right after delivery, or through a laparoscopic procedure a few weeks after delivery. It’s also really easy to do this at the time of a Cesarean delivery.

Should you get your tubes tied? For most women, the answer is no. There are two things to think about.

First, sterilization procedures still have failure rates associated with them, and the failure rate for many sterilization methods is actually higher than the failure rates for the long-acting reversible contraceptives (LARCs), like IUDs or NEXPLANON. So, if your main goal is to do the best thing to not get pregnant, you might actually be better off not getting your tubes tied and getting a LARC instead.

Second, getting a LARC is much less risky and less costly than getting your tubes tied, plus most LARCs carry fringe benefits, like better menstrual cycles. A simple five minute office procedure is definitely better than a day at the hospital and general anesthesia.

Another important issue to think about is how many children have you had and how old are you? Many women under 25, for example, might be convinced that they do not want any more children, but studies show that over time as many as 1 in 3 have serious regrets. So a 24 year old mother of two who gets her tubes tied and then decides at age 30 that she wants another child has very few good options and none that are inexpensive, but if she had instead gotten a LARC, she would have had a lower failure rate, better menstrual cycles, and easy reversibility! Finally, most doctors now recommend salpingectomy which is removal of the tubes completely rather than “tube tying” which involves clamping a small section of tube or removing a small piece of tube. Salpingectomy has the benefit of being more effective and reducing your risk of ovarian cancer but it is completely irreversible. Most women who get their tubes tied don’t have the idea of a reversal in their minds, but just know that a salpingectomy is completely irreversible. So, if in doubt, just get a LARC.

 [HH1]wordy

Great question. For most women, the most appropriate birth control choice is one of the long-acting reversible contraceptives (LARCs). The LARCs include the hormonal IUDs (Mirena, LILETTA, or Kyleena), the copper IUD (ParaGard), and the implant (NEXPLANON). These methods are the most effective, have the highest success rate (as much as 80 times more effective than the pill), have the lowest side-effect profile and lowest complication rate, and the highest patient satisfaction rates. They also don’t interfere with breastfeeding, and they will protect you for 3-10 years depending on which LARC you choose. All of them are immediately reversible if you want to get pregnant, and none of them decrease your chances of pregnancy in the future.

Click here to read more about birth control options and click here to read more about the pros and cons of each method.

This depends on the birth control method you use and how your body responds. If you have an IUD removed, it is possible for you to become pregnant the first cycle after its removal. Since IUDs don’t normally affect ovulation, it is actually possible to become pregnant just a few days after removal. The same goes for NEXPLANON, the arm rod contraceptive. Once the rod is removed, you can become pregnant within the first cycle.

If you take the combo birth control pill, which contains both estrogen and progesterone, or a progesterone-only pill, you can become pregnant also within the first cycle, as ovulation will resume within the month after you stop the pill.

Your chance of becoming pregnant in any given month of trying is around 20% or less, even if everything is normal. So, it’s not likely that you’ll become pregnant right after stopping birth control, but it is possible and you don’t need to stop it until right before you would like to become pregnant. In some cases, your menses might not resume after stopping these forms of birth control and that’s not likely to be due to the birth control, but to an underlying ovulation or fertility problem. If your periods don’t become normal after stopping any of these methods of birth control within two or three months, you should see your doctor. Even when everything is working well, it still takes several months for the average couple to get pregnant. If you’ve tried for a year and not become pregnant (or six months if you’re over the age of 35), you should see your doctor for a fertility evaluation.

When you stop the Depo-Provera shot, however, you may not have an immediate return to fertility. This is one of the down sides of the shot. It can take some women several months or even well over a year for ovulation to return. The contraceptive effect of each shot lasts for 12-15 weeks, which is why we recommend that patients get the shot every three months. Some patients choose to stop the Depo-Provera shot six months or more in advance of a planned pregnancy to avoid an unnecessary delay in conception. Barrier methods such as condoms or the diaphragm, as long as they are not used, allow for the possibility of immediate conception if you ovulate regularly. Remember, becoming pregnant may take up to a year even if there are no issues. Don’t get discouraged and make sure you are talking with your doctor throughout the process if you are worried about anything or suspect something is wrong, especially if your menses aren’t regular. 

Sex just before the time of ovulation is the best way to achieve pregnancy. The optimal time to have sex is during the five days or so leading up to the day of ovulation. Daily sex is fine, but having sex at least every other day in your “fertile window” is ideal.

Ovulation occurs 14 days before the first day of your next period. For women with a “typical’ 28-day menstrual cycle, this means that ovulation occurs on cycle day 14, where the first day of bleeding is day 1. However, not all women have a 28-day cycle. If you have a 30-day cycle, ovulation would occur on day 16 (30 minus 14) or if you have a 26-day cycle, it would occur on day 12 (26 minus 14).

Some clues that you may be ovulating include a thicker, sticky cervical mucus (resembling egg whites) or a change in basal body temperature (prior to ovulation, basal body temperature measured first thing in the morning declines slightly and immediately after ovulation it rises again). These signs are not always accurate and can be difficult to assess. Cervical mucus and body temperature are subject to wide variation from person to person. 

Over-the-counter ovulation detection kits can be purchased that are much better at determining ovulation. These urine tests are used with the first urination of the day and they detect the surge in luteinizing hormone (LH) that occurs the day before ovulation. These are not always accurate, but are much better than basal body temperature or cervical mucus monitoring and they have the benefit of determining ovulation the day before, which is an ideal day to have sex when trying to become pregnant.

If your cycle is irregular, if it is longer than 35 days, or shorter than 21 days, talk to your doctor about how you can determine when you are ovulating, or if you need an evaluation to make sure you are ovulating. We can test your blood for a surge of progesterone about 8 days after the suspected day of ovulation to confirm ovulation and there are medical treatments to help you ovulate if you do not.

These are not always necessary, but they can certainly be helpful! If there are factors in your medical or family history that you think might make getting pregnant more difficult or complicate a pregnancy, then your doctor can discuss these with you and give you advice and help to optimize your health before becoming pregnant.

If you have chronic medical problems like diabetes, hypertension, or other conditions that require you to take a medication, a preconception visit is a great idea. Getting medical conditions optimally managed with medications safe to use during pregnancy is the goal.

Yes!

In fact, taking the prenatal vitamin before becoming pregnant is ideal. Building levels of folic acid in your body helps to reduce the risk of neural tube defects and some studies show that women who take a prenatal vitamin in the months leading up to conception have less nausea and vomiting of pregnancy in the first trimester.

You don’t need anything fancy. A basic prenatal vitamin is more than enough and try to take this for at least three months before conceiving.

The most important vaccine that you should get prior to pregnancy is the MMR (measles, mumps, rubella) vaccine. Many people received this vaccine during their childhood; however, immunity can wane over time. Your doctor can order a blood test called a titer that looks at your immunity to those diseases and will decide based on your antibody levels whether you should get the vaccine again. Historically, congenital rubella syndrome was a devastating disease that affected newborns whose mothers developed rubella in the first trimester. Thankfully, because of the vaccine, this condition is now rare with fewer than 1,000 cases a year but even those are preventable.

If you are pregnant during flu season, you should have a flu shot as soon as it’s available. We also recommend that you stay up-to-date with any needed COVID booster shots and you can receive this vaccine during pregnancy if needed. Seasonal flu and COVID infections are a leading cause of maternal death and pregnancy complications and these vaccines are highly effective and safe. If you are between 32-36 weeks’ gestation during the months of September to January, you should also receive the RSV vaccine to protect your newborn against RSV infection in those peak months after birth. We also recommend the Tdap vaccine during pregnancy to protect you and your newborn against whooping cough (pertussis). We recommend this between 27-36 weeks’ gestation to optimize the production and transmission of antibodies across the placenta to protect your newborn. If you happen to receive this shot earlier in pregnancy for some reason (maybe you stepped on a nail), you don’t need to repeat it later.

Cytomegalovirus (CMV) is a virus related to the herpes viruses. It is so common that up to 85% of adults in the United States have been infected at some point in their lives.

Usually, CMV is a mild disease that does not cause any serious problems in healthy children and adults. Most people get flu-like symptoms or cold-like symptoms for a few days, if they develop any symptoms at all. However, some people, including immune-compromised women and newborn babies of women infected with CMV during pregnancy, can have serious complications and even death.

Pregnant women infected with CMV for the first time during pregnancy can pass the virus to their unborn babies. The virus can also pass from mother to baby in vaginal secretions during delivery and in breast milk after birth. The virus can pass from person to person through blood, saliva, breast milk, and urine.

Up to 40% of babies born to women who are newly infected with CMV during pregnancy will become infected. Not all infected babies will have symptoms at birth.

Newborns with CMV are likely to be born early and weigh less. Other possible problems include a small brain (microcephaly) or other nervous system disorders that can cause seizures, deafness, mental retardation, or death. This infection can cause the liver and spleen to become larger than normal, as well as jaundice, and blood disorders. Newborns with CMV may have a rash that consists of small bruises called petechiae and larger bruises known as purpura. Some of these findings can be detected with ultrasound, but most cannot.

A baby born to a mother who was already infected with CMV before she became pregnant is less likely to be born with CMV due to some preexisting immunity. Only 0.5% to 1.5% of such babies are infected (compared to 40% of babies born to mothers who were infected during pregnancy), and their problems tend to be less severe.

There are currently no treatments for maternal or fetal CMV infection.

The pediatrician may order blood tests for babies with low birth weight, jaundice, small brains, or other problems that can be associated with congenital CMV. The diagnosis needs to be confirmed by testing blood or tissue from the infant within three weeks of birth to be accurate.

Young, healthy pregnant women usually do not need to be tested because they do not need to be treated specifically for CMV. They usually recover over a period of weeks. In some instances, blood tests may be done to confirm the cause of the illness, since similar symptoms can be caused by the Epstein-Barr virus (EBV) and even human immunodeficiency virus (HIV). Some of the antibody tests used to test for CMV have a high false-positive rate and the testing needs to be repeated to be reliable.

Pregnant women who care for young children should take these precautions to reduce the risk of CMV:

• Wash hands often with soap and water, especially after changing diapers. Wash well for 15 to 20 seconds.
• Do not kiss young children under the age of five or six on the mouth or cheek. Instead, kiss them on the head or give them a big hug.
• Do not share food, drinks, or utensils (spoons, forks, or knives) with young children.

If you are pregnant and work in a daycare center, reduce your risk of getting CMV by working with children who are older than two and a half years of age, especially if you have never been infected with CMV or are unsure if you have been exposed.

Some amount of bleeding during the first trimester is very common, affecting about one-third of pregnant women. Avoid sex if you are bleeding until you can discuss the bleeding with your doctor or it resolves. Bleeding increases your risk of miscarriage, but, surprisingly, not by very much. 

If you are having heavy bleeding and cramping, you need to be seen. Bleeding later in pregnancy may be a sign of labor or other problems. It can also be normal. A lot of women will spot later in pregnancy, especially if their cervix is starting to slowly make change. Always discuss heavy bleeding with your doctor immediately. This is almost never a reason to go the emergency department, but it is a reason to be seen in the office in the next day or two.

A general rule is to only bathe or soak in water that is comfortable to you. To be specific, we ask that you keep your water temperature below 100-102°F. The goals of this are:

• Don’t burn your skin and 
• Don’t send yourself into heat stroke/exhaustion. 

You should be able to gauge if the temperature of the water you’re getting into is going to cause either of these things. No thermometer is needed. If you do like hot baths or showers, just remember that you can get dehydrated quickly and maybe keep a cold water and a chair or stool by the tub. Also, get yourself a non-slip bath mat! 

Many hot tubs might be set to 104°F or higher. One study from the 1990s showed that soaking in a hot tub at this higher temperature during the first trimester may be associated with neural tube defects in babies. Because of this study, we recommend to avoid temperatures that high for long periods of time, especially in the first trimester. The research is weak, but it is certainly something to consider.  Hot tubs are different that most baths because the water is maintained at that higher temperature and your body is typically submerged with little opportunity to cool off. But with baths in your home, the water starts to cool immediately after its drawn so it doesn’t raise your core body temperature in the same way or to the same extent as a hot tub might.

Glycol ethers are a type of chemical used in some clearning products and these should be avoided. Examples of glycol ethers are  2-butoxyethanol (EGBE) and methoxydiglycol (DEGME). Glycol ethers are solvents that have been linked to miscarriage and birth defects. Check the ingredients of the products listed below before you buy them. A list of products that may contain a glycol ether: 

• Resins, lacquers, house paints
• Dyes, inks, some water based paints
• Hydraulic fluids
• Degreasing cleaning agents

A general thing to avoid, not just in pregnancy, is the combination of ammonia and bleach when cleaning. This creates a poisonous gas that can be very harmful to you.

Paints that contain lead or the above mentioned glycol ethers should be avoided, but modern paints don’t have these substances. Keep the area well ventilated no matter what paints you are using. Other recreational paints for artistic use are generally safe, including watercolors, acrylic, and tempera paints. 

Anything you normally do when you feel that way! Sit or lay down, have someone get you some water and food, and give yourself some time to let the feeling pass. Laying on your left side is best so that your uterus rolls off of the blood vessels bringing blood back to your heart. The most important thing is avoiding falling down and hurting yourself. So, as soon as you feel woozy or dizzy, sit or lay down on the ground or in a chair.

Most of the time, the problem is a lack of blood to your head. When you’re pregnant, blood tends to collect in your legs. Your blood vessels relax to allow for increased blood volume and your uterus puts pressure on the vena cava, which is the large vein that draws blood back from your legs to your heart. These factors mean that more blood stays in your legs and that blood has a harder time getting back to your heart. Because of this, there is relatively less blood going to your head sometimes and this may make you feel like you are going to faint.

Blood moves up from your lower extremities with movement of the muscles in your legs. The veins in your legs run through the muscles; when the muscles work, they squeeze the blood upwards back to your heart. So moving your legs helps whereas standing very still may contribute to you passing out. You also may want to wear compression socks to help blood flow and reduce swelling. You should certainly try to maintain good fluid and food intake throughout the day to keep your energy up. Also avoid heat like hot showers. Your blood vessels will dilate even more when you are hot and a really hot shower in the morning could cause you to pass out. Conversely, you might feel better with a cool rag on the back of your neck.

You shouldn’t be worried about lifting general items around the house, the store, or work. This being said, if you work on an assembly line in a factory or in some other job that requires routine repetitive heavy lifting, it may be best to ask your doctor about your specific situation. But for the most part, occasional and recurrent lifting of any amount you normally lift in the course of your home or work life is not usually going to be a problem. This includes any babies or small children you have at home. 

Still, lifting the right way is very important: bend at your knees, try to keep your back straight, and lift up with your legs. This will help prevent unnecessary strain or sprain on your muscles and joints which are already a bit overworked when you are pregnant. 

It’s unclear if repetitive heavy lifting is associated with adverse pregnancy outcomes, but it certainly can make the normal aches and pains of pregnancy much worse. At the gym, light weights and repetitions are fine, but it’s probably not the time to set your new personal records for lifting. At work, it depends on how far along you are and how much lifting you do. Click here for a graphic that shows a very conservation approach to limiting problems associated with repetitive lifting while you’re pregnant.

There are lots of skin changes that might happen during pregnancy; some are due to physiologic and hormonal changes and some are more serious. Let’s talk about some of the more common ones.

Spider angiomas. These are little vascular spots that can show up on your skin during pregnancy. They are typically not concerning and will go away when you are no longer pregnant. The only time we would be concerned by them is if you have a history of liver problems or if you began having symptoms that would be concerning for a liver problem (which is rare). 

Linea nigra. This is a normal dark vertical line that can arise from your belly button down towards your pubic bone. It develops because of certain hormonal changes but it will fade away partially once the baby is born. During pregnancy, the placenta develops a hormone called melanocyte-stimulating hormone (MSH). This extra MSH stimulates some cells to make extra melanin which causes these cells to get darker.

Darkened areolae and darkened armpits. There are a lot of changes that may occur with the breasts during pregnancy. The nipples and areolae may become a darker shade due again to extra MSH. Similarly, the color should fade back to near its usual color after the baby is born. While this is completely normal, any redness of the breast should be investigated further by your doctor. The same thing goes for the arm pits. You may notice that they are darker, and may even look a gray or brown color. This is normal and will fade mostly back to normal as well once the baby is born. 

Melasma. Another case of hyperpigmentation in pregnancy! Are you kidding me?! Are you noticing a theme yet? Unfortunately, this one occurs on the face and women typically do not like it. It will appear as a gray or brown patchy/spotty or general change in the coloration of the face. What may be more upsetting to hear is that we don’t have a good treatment for it. If it’s still present a few months after you’ve delivered, talk to your doctor about possible treatments. You can prevent it from getting worse by using sun protection like sunscreens, hats, etc. Any sun exposure can make it worse. 

Polymorphic eruption of pregnancy (PEP). PEP is a rash of pregnancy that can occur during the third trimester on the abdomen and sometimes upper thighs. This previously was called pruritic urticarial papules and plaques of pregnancy (PUPPP). It will be very itchy and look like plaques, red bumps, or even hive-like. It can start out in the stretch marks and is not harmful to you or baby, but can be very annoying for you because of the itch. Treatment is a topical steroid cream that your doctor will prescribe for you, and possibly an oral antihistamine (e.g., Benadryl) to control the itch. Cool wet compresses and oatmeal baths may help with the itching.Pemphigoid gestationis. This rash can occur during the second or third trimester or sometimes right after delivery. This can have similar features to PEP but can extend further on your body beyond legs and thighs. It may develop blisters as well. The treatment is the same as it is for PEP. There are some other causes of rash and itching as well, including atopic eruption of pregnancy and pustular psoriasis of pregnancy. Remember, if your main symptom is intense itching without a rash, be sure to discuss intrahepatic cholestasis of pregnancy with your doctor as this requires medical treatment and earlier delivery.

Unfortunately, there has not been quality evidence showing that chiropractic alignment will help with delivery. Until there is solid evidence supporting it, we don’t recommend it. One thing often recommended is the “Webster technique.” This is supposed to ensure that the breech or transverse baby is head down by the end of the pregnancy. Most babies will be head down by 37 weeks’ or so and this technique is no better than random chance at making sure your baby is head down at term. Don’t waste your money.

No. If this were the case, we would ask patients to eat dates as their due-dates approached and avoid them before that. Alas, there is no evidence to back up this claim. So, eat the dates or don’t, but your cervix will do what it is going to do regardless.

Babies love being unpredictable. If there were a way to induce labor through drinking tea, exercise, sex, or some other magic, we would tell you. Like eating dates, there are dozens of such claims and the reason so many fibs exist is simple: women eventually go into labor and sometimes they will falsely contribute whatever they did immediately prior to labor as the reason things got going. The stronger the correlation of the timing between the onset of labor and the thing they did, the stronger the belief. But actually the body just does what it is going to do on its own terms. Unless you go into labor spontaneously, the only thing we can do to induce its onset is medication. 

This is not an uncommon situation. Many women don’t realize they are pregnant and consume alcohol during those early weeks of gestation before they realize it. Unfortunately, there is no way to diagnose fetal alcohol syndrome until the baby is born. In some severe cases it can be diagnosed right at birth, but most cases are not detected until early childhood, and some very mild cases may not be detected at all. 

No amount of alcohol during pregnancy has been deemed safe, and the amount of alcohol consumed is a poor predictor of outcomes. The only way we can determine the effects of any alcohol consumption you might have had is by assessing the child during their development and seeing how they are doing with their cognitive, behavioral, and other developmental milestones. It is best to try and avoid alcohol when you are thinking about conceiving. Once you find out you are pregnant, cut out alcohol and avoid it for the rest of the pregnancy if you have not already done so. 

In the first trimester, certain hormones your pregnant body makes can stimulate urine production and the urge to pee. As the baby grows and the uterus expands, the bladder, located directly in front of the uterus, gets compressed. This means the bladder probably holds less urine before you develop the urge to pee. These forces conspire together to make pregnant women pee a million times a day. It is important to remember that if you feel you are peeing an unusual amount with burning, you might have a UTI. Talk to your doctor about doing a urine culture.

What can help you stop peeing so much, you ask? First, don’t stop drinking fluids. You need them to stay hydrated! But you can cut down on them right two to three hours before you go to bed to avoid so many nighttime interruptions. Avoid caffeine drinks if you can. In the third trimester, try positional changes to avoid compression of the bladder by the uterus.

REM (rapid eye movement) sleep is the term we use for deep restful sleep when people experience vivid dreams. Pregnant women actually experience more REM sleep and therefore may feel like they have more vivid dreams as well as more frequent dreams. Their sleep is also disrupted more often due to things like discomfort, restless legs, frequent urination, etc. Restless sleep can also lead to an increase in hypnagogic hallucinations, which are the abnormal sensations that occur right as you are falling asleep (like a sensation of falling, strange smells, etc.).

The result of all of this is that pregnant women tend to remember more of their dreams. Sometimes, our anxieties play themselves out in dream scenarios so it’s not uncommon for your dreams to contain content that might be disturbing (things like losing the pregnancy or your child being hurt or injured in some way). If you find that the content of your dreams is particularly disturbing, talk to your doctor

This is a preference thing: there is no right or wrong answer here. You are not required to bring anything aside from your ID and insurance card if you have them. The rest of your bag should be things that bring you comfort. 

If you do a labor and& delivery tour at some point before you deliver (most hospitals offer this), you can ask what amenities they have that you may want (bath, bouncy bouncing balls, fan, etc.) If they do not have these things then you may want to bring them. 

Things the hospital will provide: sanitary pads for you after delivery, diapers, formula, bottle nipples, food/drink, gowns, and hygiene products for showering.

Things you may want: phone charger, socks, snacks, your own clothes/robe/toiletries that you prefer, multiple changes of clothes (you may be very sweaty/uncomfortable during the labor period), slippers, shower shoes (hospital showers should be clean but still), etc. Think about going away on a trip to a hotel for 3 days or so and pack whatever you would take for that

Mood swings are common in pregnancy and may be self-limited. Pregnant women are tired, often anxious about the pregnancy and the changes of life occurring, and are busy preparing for a new baby. There isn’t too much we can do for you here. But, it is important to distinguish an occasional mood swing from depression or anxiety. If you feel like your mood swings are uncontrollable and really, really bad, you should discuss them with your doctor so they can make sure that something more serious isn’t going on. The best way to take care of perinatal mental health problems is by catching them early. Many pregnant women, however, just have some overwhelming moments and don’t necessarily have an underlying mood disorder like depression or anxiety.

The best thing to do for these sorts of mood swings is personal soothing techniques. This might mean setting aside some personal time during your day or week, talking to your friends and family about things they can do to help you, or finding a confidant or therapist to talk things through with.  Mood swings are a part of pregnancy. There are a lot of changes going on with your body and your life. It is important to know that you can do this, and your doctor and your support system should be there to help every step of the way.

Cutting out smoking completely is very difficult for most patients, but doing so can drastically reduce the risks to your pregnancy and your own health. There are a number of nicotine replacement therapies (NRT) such as: nicotine gum, patches, tablets, lozenges, inhalers (not the same thing as a vape), sprays, and strips. 

E-cigarettes are not a good option because they are not licensed or controlled for safety in pregnancy and we have no evidence that they are any safer in the long-term than cigarettes. 

Giving up smoking cold-turkey is hard. If you can give yourself time to quit gradually during the time when you are trying to get pregnant, this might be more effective. This involves reducing the number of cigarettes you smoke by one or two every week until you are completely off of cigarettes.

If you are pregnant and trying to stop smoking, you can also try substituting cigarettes with one of the NRTs mentioned above. This could mean using a patch and quitting all cigarettes or using an inhaler or gum and replacing a single cigarette here and there as you cut down. The goal is to get you to stop and stop for good, rather than quit for a week, and then fall off the bandwagon and start up all over again. 

When you are tempted to smoke, try the following:

• Delay the act of smoking as long as you can (and substitute it with an NRT if you can)
• Deep breaths
• Drink water
• Do something else (something with your hands is best)

We have medications that can help with the urges. Talk to your doctor to see if these are right for you.

Miscarriage is defined as an early pregnancy loss that occurs at less than 20 weeks’ gestation. Miscarriages are common and become more common the older you get, ranging from about 1 in 6 known pregnancies for younger women to 1 in 3 or older women. Miscarriage can be due to a number of reasons and the most common cause is a chromosomal abnormality that is not compatible with life. About 95% of miscarriages happen very early, usually before six weeks’ gestation. 

After multiple miscarriages, there are certain conditions we can test for that are associated with recurrent pregnancy loss. Late pregnancy losses (after 20 weeks) are always investigated because these are more likely to be due to a specific cause. 

Miscarriage can be a very disheartening thing, but a single miscarriage does not increase your risk of having another miscarriage! That is very important to know. 

AMA is defined as 35 years or older at the estimated time of delivery. This feels harsh to say, we know. This designation was created in the 1970s to indicate patients who had higher risk of fetal chromosomal problems like Down syndrome and was made as a billing code for women who wanted to pursue testing for these issues. There are some issues with being pregnant at an older age but those risks are largely based upon your overall health status, not your age alone.

Early in pregnancy, you will have your blood type checked (e.g., A+, A-, B+, etc.). The + or – indicates your Rhesus (Rh) status. We pay attention to Rh in pregnancy because if mom is Rh negative, we give her RhoGAM (or an equivalent product) near the 28 week visit, and possibly at the time of delivery if the baby is Rh positive. The reason we give this is so that the mother doesn’t form antibodies to the baby’s blood. If mom were to create her own antibodies to the baby’s blood, it could cause a fetal anemia and perhaps death in future pregnancies if the fetus were Rh positive. If mom is Rh positive, we don’t have to worry about any of this. 

Between 24 and 28 weeks’ gestation, we will perform a glucose screening test for gestational diabetes. We will have you drink 50 grams of glucose and then check your blood sugar in an hour. If you fail this screening test, then we will have you take a diagnostic 3-hour glucose tolerance test. If you fail that test as well, you will be diagnosed with gestational diabetes. Depending on how your blood sugars are, you may just be closely monitored and encouraged to change your diet and activity level to maintain normal blood glucoses. If your sugars are not well controlled in pregnancy, then you may need to be started on insulin. Each person will have an individualized treatment plan. Gestational diabetes increases your risk of a large baby, possible shoulder dystocia at pregnancy, and risk for a Cesarean delivery. It also increases your lifetime risk of developing type 2 diabetes and the newborn may have low blood sugars at birth and a few other issues your pediatrician will check on.

This is a disorder of pregnancy during which a pregnant woman has excessive nausea and vomiting to the point she has weight loss, dehydration, and volume depletion that can lead to ketones in the blood/urine, other electrolyte abnormalities, and often an inability to do daily activities. It may require hospital admission and nutrient/fluid repletion within the hospital. It usually occurs in the first or early second trimester.

This is also a blood pressure disorder of pregnancy that is diagnosed by two blood pressures taken at least four hours apart that are ≥ 140/90 and evidence of protein in your urine. You must be 20 weeks’ gestation or more in order to be diagnosed with this disorder, and your physician will order more labs to determine if there is any associated organ damage or blood problems occurring because of how the disease progresses. Depending on the severity of the disease and when it is diagnosed, you may require blood pressure medications and/or IV magnesium sulfate that helps prevent seizures from occurring. The goal will also be delivery at 37 weeks’ gestation unless the disease progresses and warrants earlier delivery for safety of baby and mom. It you have “severe features,” you will be delivered no later than 34 weeks’ gestation.

This is a blood pressure disorder of pregnancy that is diagnosed by two blood pressures taken at least four hours apart that are ≥ 140/90. You must be at least 20 weeks’ gestation in order to be diagnosed with this disorder and have no history of hypertension. We will usually not treat this condition with medication unless the blood pressure warrants it or it progresses in certain ways. However, we will monitor your pregnancy more closely and deliver you at 37 weeks’ gestation (term). 

There are several types of twins. The type of twin pregnancy depend on whether it results from one egg or two, and if one egg, depending on when the embryo splits. Twins that result from one fertilized egg are called monozygotic twins and twins from two fertilized eggs are called dizygotic twins.

All dizygotic twins have two placentas; this is called dichorionic. They also have two internal compartments (amniotic sacs) which is called diamniotic. They are also called fraternal twins.

Monozygotic twins that split very early will also be dichorionic-diamniotic but they will be identical since they came from the same embryo. However, if they split a bit later, they may have only one placenta; this is called monochorionic. Monochorionic twins can also be diamniotic with a dividing membrane between the two fetuses but they can also have no dividing membrane; this is called monoamniotic.

All types of twin pregnancies are at an increased risk for essentially every complication of pregnancy, including preterm birth, gestational diabetes, hypertensive disorders of pregnancy such as gestational hypertension or preeclampsia, and of course more aches and pains and all of the other joys of pregnancy. Monochorionic pregnancies, however, have some special risks including a risk for twin-to-twin transfusion syndrome (TETS) for monochorionic-diamniotic twins and a risk of cord entanglement for monochorionic-monoamniotic twins. Because of this, monochorionic twins are much higher risk than dichorionic twins and require significantly more testing.

Most twin pregnancies can still be delivered vaginally as long as the first twin is head down. The one important exception to this is monochorionic-monoamniotic twins; because of cord entanglement, these pregnancies need to be delivered by Cesarean delivery.